1598975146 NPI number — SEYMORE CHIROPRACTIC AND PHYSICAL THERAPY CENTERS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598975146 NPI number — SEYMORE CHIROPRACTIC AND PHYSICAL THERAPY CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEYMORE CHIROPRACTIC AND PHYSICAL THERAPY CENTERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598975146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/14/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 BALTIMORE PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEL AIR
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21014-4244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-877-8077
Provider Business Mailing Address Fax Number:
410-877-8577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21014-4244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-877-8077
Provider Business Practice Location Address Fax Number:
410-877-8577
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SEYMORE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-877-8077

Provider Taxonomy Codes

  • Taxonomy code: 111NR0400X , with the licence number:  03390 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 0013 CCCN , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 20804 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 20804 PT , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2162892 . This is a "FIRST HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 446469 . This is a "COVENTRY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 64514901 . This is a "BCBS RENDERING NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2146627 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0117137 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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